Case Studies

 Case 4.6 Allergic asthma

A 15-year-old girl presented with a prolonged wheezing attack which had suddenly come on 36h earlier. She had experienced several episodes of 'wheezy bronchitis' as a child and eczema as an infant. She was a non-smoker. Her father suffered from hay fever but there was no family history of asthma. On examination, she was tired and unwell, with a rapid respiratory rate and tachycardia (140/min). There were bilateral expiratory rhonchi on chest auscultation. Investigations showed a normal haemoglobin but a raised white cell count (14 x 10⁹/l). Her sputum contained many eosinophils. A chest X-ray was normal but lung function tests showed reversible airways obstruction. Skin tests showed an immediate reaction to six common antigens. The clinical diagnosis was asthma and the family history and skin tests suggested this was allergic asthma. She continues to have periodic attacks of asthma, although they are controlled, in part, by prophylactic inhaled steroids and beta₂-adrenergic stimulants (salbutamol).